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Archives of Disease in Childhood Feb 1974Twelve seriously malnourished Jamaican babies were investigated before and after treatment to discover whether they were unduly susceptible to heat in the malnourished...
Twelve seriously malnourished Jamaican babies were investigated before and after treatment to discover whether they were unduly susceptible to heat in the malnourished state. On exposure to an environmental temperature of 38 °C at low humidity their mean rectal temperature increased at a rate of 0·75 °C/hour when they were malnourished, while after recovery it showed little change. During heat exposure total evaporative water loss in the recovered children was, on average, 44% greater than it was in the malnourished state, and in the malnourished children there was a significant inverse relation between total evaporative water loss and rise in rectal temperature. Measured sweat loss under a ventilated capsule after an intradermal diaphoretic injection in 7 of the children confirmed that sweating was impaired when they were malnourished. Rectal and skin temperatures at sweat onset were unchanged after recovery, indicating that central homoeostatic mechanisms were probably not disturbed. Peripheral vasodilatation in response to heat was unimpaired. Children with severe skin lesions had the most defective sweating, and malnutrition may damage the sweat glands as it does the hair follicles. It is very important to nurse malnourished children at the correct temperature; an environmental temperature of about 29 °C is satisfactory in most cases.
Topics: Blood Flow Velocity; Blood Vessels; Body Temperature Regulation; Body Water; Dilatation; Female; Hair; Homeostasis; Hot Temperature; Humans; Infant; Infant Nutrition Disorders; Jamaica; Male; Nutrition Disorders; Skin Diseases; Skin Temperature; Sweat Glands; Sweating; Temperature
PubMed: 4817444
DOI: 10.1136/adc.49.2.123 -
BMC Research Notes May 2017Ventricular tachycardia is a life threatening cardiac arrhythmia. It needs management with defibrillation, without which, immediate death may occur.
BACKGROUND
Ventricular tachycardia is a life threatening cardiac arrhythmia. It needs management with defibrillation, without which, immediate death may occur.
CASE PRESENTATION
A 66 year old black African patient with a 2 year history of hypertension was admitted to the emergency department of the Buea Regional hospital, a semi-urban setting in Cameroon, after presenting with syncope while in church. The wife described a similar episode 2 weeks prior without any further evaluation. Upon arrival at the emergency, patient had regained consciousness but lethargic, tachypneic and diaphoretic. The blood pressure was 85/61 mmHg; the pulse was 219/min, weak and thready. He had cold extremities. A 12 lead electrocardiogram performed showed a sustained monomorphic ventricular tachycardia at 230/min. He was administered six tablets of amiodarone, oxygen by nasal cannula and intravenous fluids. No electrical cardioversion was attempted due to the non availability of a defibrillator. Outcome was fatal with death of the patient 30 min after his arrival to the emergency.
CONCLUSION
Our health facilities should be well equipped for resuscitative measures by adopting Advanced Cardiac Life Support as cardiovascular diseases are becoming more frequent in our settings.
Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Cameroon; Electrocardiography; Fatal Outcome; Heart Rate; Humans; Male; Syncope; Tachycardia, Ventricular; Treatment Failure
PubMed: 28482930
DOI: 10.1186/s13104-017-2501-4 -
Pain Physician 2012Digital subtraction angiography (DSA) has been touted as a radiologic adjunct to interventional neuraxial procedures where it is imperative to identify vascular...
Digital subtraction angiography (DSA) has been touted as a radiologic adjunct to interventional neuraxial procedures where it is imperative to identify vascular compromise during the injection. Transforaminal epidural steroid injections (TFESI) are commonly performed interventions for treating acute and chronic radicular spine pain. We present a case of instantaneous and irreversible paraplegia following lumbar TFESI wherein a local anesthetic test dose, as well as DSA, were used as adjuncts to fluoroscopy. An 80-year-old man with severe lumbar spinal stenosis and chronic L5 radiculopathic pain was evaluated at a university pain management center seeking symptomatic pain relief. Two prior lumbar interlaminar epidural steroid injections (LESI) provided only transient pain relief, and a decision was made to perform right-sided L5-S1 TFESI. A 5-inch, 22-gauge Quincke-type spinal needle with a curved tip was used. Foraminal placement of the needle tip was confirmed with anteroposterior, oblique, and lateral views on fluoroscopy. Aspiration did not reveal any blood or cerebrospinal fluid. Digital subtraction angiography was performed twice to confirm the absence of intravascular contrast medium spread. Subsequently, a 0.5 mL of 1% lidocaine test dose was performed without any changes in neurological status. Two minutes later, a mixture of one mL of 1% lidocaine with 80 mg triamcinolone acetonide was injected. Immediately following the completion of the injection, the patient reported extreme bilateral lower extremity pain. He became diaphoretic, followed by marked weakness in his bilateral lower extremities and numbness up to his lower abdomen. The patient was transferred to the emergency department for evaluation. Magnetic resonance imaging (MRI) of the lumbar and thoracic spine was completed 5 hours postinjection. It showed a small high T2 signal focus in the thoracic spinal cord at the T7-T8 level. The patient was admitted to the critical care unit for neurological observation and treatment with intravenous methylprednisolone. Follow-up MRI revealed a hyper-intense T2 and short-tau inversion recovery signal in the central portion of the spinal cord beginning at the level of the T6 superior endplate and extending caudally to the T9-T10 level with accompanying development of mild spinal cord expansion. The patient was diagnosed with paraplegia from acute spinal cord infarction. At discharge to an acute inpatient rehabilitation program, the patient had persistent bilateral lower extremity paralysis, and incontinence of bowel and bladder functions. In the present patient, DSA performed twice and an anesthetic test dose did not prevent a catastrophic spinal cord infarction and resulting paraplegia. DSA use is clearly not foolproof and may not be sufficient to identify potentially life-or-limb threatening consequences of lumbar TFESI. We believe that this report should open further discussion regarding adding the possibility of these catastrophic events in the informed consent process for lumbar TFESIs, as it has for cervical TFESI. Utilizing blunt needles or larger bevel needles in place of sharp, cutting needles may minimize the chances of this event occurring. Considering eliminating use of particulate steroids for TFESI should be evaluated, although the use of nonparticulate agents remains controversial due to the perception that their respective duration of action is less than that of particulate steroids.
Topics: Aged, 80 and over; Anesthetics, Local; Angiography, Digital Subtraction; Humans; Injections, Epidural; Lidocaine; Lumbosacral Region; Male; Paraplegia; Radiography, Interventional; Spinal Cord Ischemia; Spinal Stenosis
PubMed: 23159970
DOI: No ID Found -
Singapore Medical Journal Feb 2004Hydroxyzine is a first generation antihistamine widely used in the paediatric population for a variety of conditions. A nine-year-old girl presented with...
Hydroxyzine is a first generation antihistamine widely used in the paediatric population for a variety of conditions. A nine-year-old girl presented with supraventricular tachycardia while on clinical doses of hydroxyzine for pruritus. On arrival at the hospital, she was diaphoretic, with cool peripheries, poor peripheral pulses and a heart rate of 250/minute. There was a history of three palpitation episodes with chest tightness during the five months she was taking hydroxyzine. The supraventricular tachycardia eventually reverted to sinus rhythm with intravenous verapamil. Relevant cardiac examination and investigations had not shown any cardiac abnormalities. After discontinuing hydroxyzine, she had no further episodes of supraventricular tachycardia. To our knowledge, this is the first report of hydroxyzine induced-supraventricular tachycardia in the medical literature.
Topics: Child; Female; Histamine H1 Antagonists; Humans; Hydroxyzine; Tachycardia, Supraventricular
PubMed: 14985850
DOI: No ID Found -
Evidence-based Complementary and... Sep 2006Teucrium polium L. (Lamiaceae) (RDC 1117) is a medicinal plant whose species have been used for over 2000 years in traditional medicine due to its diuretic, diaphoretic,...
Teucrium polium L. (Lamiaceae) (RDC 1117) is a medicinal plant whose species have been used for over 2000 years in traditional medicine due to its diuretic, diaphoretic, tonic, antipyretic, antispasmodic and cholagogic properties. The therapeutic benefit of medicinal plants is often attributed to their antioxidant properties. We previously reported that an aqueous extract of the leaves and stems of this plant could inhibit iron-induced lipid peroxidation in rat liver homogenate at concentrations that were not toxic to cultured hepatic cells. Others have reported that organic extracts of the aerial components of this plant could inhibit oxidative processes. Against this background, we felt further investigation on the antioxidant action of the extract of T. polium prepared according to traditional Arab medicine was warranted. Accordingly, we assessed (i) its ability to inhibit (a) oxidation of beta-carotene, (b) 2,2'-azobis(2-amidinopropan) dihydrochloride (AAPH)-induced plasma oxidation and (c) iron-induced lipid peroxidation in rat liver homogenates; (ii) to scavenge the superoxide (O2*-) radical and the hydroxyl radical (OH(*)); (iii) its effects on the enzyme xanthine oxidase activity; (iv) its capacity to bind iron; and (v) its effect on cell glutathione (GSH) homeostasis in cultured Hep G2 cells. We found that the extract (i) inhibited (a) oxidation of beta-carotene, (b) AAPH-induced plasma oxidation (c) Fe(2+)-induced lipid peroxidation in rat liver homogenates (IC(50) = 7 +/- 2 mug ml(-1)); (ii) scavenged O2*-(IC(50) = 12 +/- 3 mug ml(-1)) and OH(*) (IC(50) = 66 +/- 20 mug ml(-1)); (iii) binds iron (IC(50) = 79 +/- 17 mug ml(-1)); and (iv) tended to increase intracellular GSH levels resulting in a decrease in the GSSG/GSH ratio. These results demonstrate that the extract prepared from the T. polium possesses antioxidant activity in vitro. Further investigations are needed to verify whether this antioxidant effect occurs in vivo.
PubMed: 16951717
DOI: 10.1093/ecam/nel028 -
Nihon Ronen Igakkai Zasshi. Japanese... Feb 1998A 66-year-old woman with a 7-year history of Parkinsons' disease was admitted to our hospital because of a high fever and disturbance of consciousness. She had been...
[Malignant syndrome associated with disseminated intravascular coagulation and a high level of amylase in serum, followed by diabetic coma in an elderly patient with Parkinson's disease during L-dopa therapy].
A 66-year-old woman with a 7-year history of Parkinsons' disease was admitted to our hospital because of a high fever and disturbance of consciousness. She had been treated with levodopa/benserazide hydrochloride and trihexyphenidyl hydrochloride until admission. On admission, the patient was comatose, her temperature was 40.5 degrees C, her blood pressure was 54/-mmHg, and her pulse rate was 130 beats/min. Laboratory tests showed leukocytosis, a high level of creatine kinase in serum and evidence of hyperosmolar non-ketotic diabetic coma (blood glucose, 1,080 mg/dl) and of disseminated intravascular coagulation (DIC). A continuous insulin infusion, antibiotics, nafamostat mesilate, and urinastatin were given, after which the DIC, hyperglycemia, and the level of consciousness were improved. However, levels of creatine kinase, myoglobin, transaminase, and amylase in serum continued to increase, and multiple organ failure was suspected. Furthermore, she became less responsive, diaphoretic, and tremulous; fever and mild rigidity developed. The peak creatine kinase and myoglobin were 11,095 U/l and 12,520 ng/ml, respectively. A diagnosis of malignant syndrome was made, and treatment with levodopa/carbidopa and dantrolene was begun. Within several days, the clinical and laboratory findings improved. We report here a rare case of malignant syndrome associated with DIC followed by diabetic coma in an elderly patient with Parkinsons' disease during L-dopa therapy. Timely diagnosis and treatment of malignant syndrome are important in the management of elderly patients with Parkinsons' disease, because DIC and multiple organ failure may occur in the early stages of malignant syndrome.
Topics: Aged; Amylases; Diabetic Coma; Disseminated Intravascular Coagulation; Female; Humans; Levodopa; Neuroleptic Malignant Syndrome; Parkinson Disease; Substance Withdrawal Syndrome
PubMed: 9584493
DOI: 10.3143/geriatrics.35.139 -
The American Journal of Cardiology Nov 1989To determine the prevalence and characteristics of acute myocardial infarction (AMI) patients who present to emergency departments with normal or nonspecific... (Clinical Trial)
Clinical Trial Comparative Study
Clinical characteristics and outcome of acute myocardial infarction in patients with initially normal or nonspecific electrocardiograms (a report from the Multicenter Chest Pain Study).
To determine the prevalence and characteristics of acute myocardial infarction (AMI) patients who present to emergency departments with normal or nonspecific electrocardiograms (ECGs), data were analyzed from 7,115 consecutive patients in the Multicenter Chest Pain Study. AMI patients with normal or nonspecific initial ECGs (n = 107) were less likely to have a past history of coronary artery disease or to be diaphoretic on presentation (p less than 0.01) than AMI patients with initial ECGs highly suggestive of AMI (n = 811). The overall probability of AMI among patients with chest pain and initially normal or nonspecific ECGs was 3%, but ranged from less than 1 to 17% depending on the patient's age and sex and whether the patient had pressure-type pain or pain radiating to the shoulder, neck or arms. Among initially admitted patients, the time elapsed between onset of pain and presentation was similar in both groups. However, the time between onset of pain and definitive diagnosis of AMI by enzymes or clinical course was longer in patients with initially normal or nonspecific electrocardiograms (8.3 vs 7.5 hours, p less than 0.05), their peak creatine kinase levels were lower (mean 643 vs 1,032 mg/dl, p less than 0.001) and their mortality was slightly lower (6 vs 12%, p = 0.10). These findings suggest that AMI patients with initially normal or nonspecific ECGs may have a less severe short-term clinical outcome.
Topics: Adult; Creatine Kinase; Electrocardiography; Female; Follow-Up Studies; Heart; Heart Arrest; Humans; Isoenzymes; Male; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction; Prevalence; Prognosis; Radionuclide Imaging; Risk Factors; Single-Blind Method
PubMed: 2683709
DOI: 10.1016/0002-9149(89)90857-6